[Hip and pelvic traumata in children (author's transl)].
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Biomedical subjects
Publications and source records attributed to H Carlioz.
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Proximal disinsertion of the subscapularis is an effective operation in the correction of an abnormal position in internal rotation of the shoulder. Such a decision should be taken only if the head of the humerus is still well rounded. Restoration of movement by muscular transfer of active external rotation is performed in subsequent months only if the teres minor and infraspinatus muscles do not recover spontaneously.
Repeated fractures are not unusual in the course of forearm fractures in children. 49 cases were reviewed in this work. Some of them result from insufficient duration of the plaster. Other fractures are due to the weakness of the forearm bones after the fractures especially when there is a residual malalignment. The findings of this work emphasize the importance of the reduction even when the displacement is moderate. Open reduction and internal fixation is reserved in only rare cases.
A wide exposure of the hip joint is often necessary in the treatment of congenital dislocation of the hip: Salter's or Olliers's approach, and in that of epiphysiolysis: Dunn's approach. This description of these approaches completes a review of the surgical approaches which are used in the child.
It exist multiple approaches to the hip in the child. This first section is devoted to a description of those approaches which offer only limited exposure of the joint. Alongside the medial approach used for joint puncture and the obturator approach, scarcely of any use, three important approaches respecting the integrity of the gluteal muscles may be used: those of Hueter and of Watson-Jones, to the anterior aspect of the neck of the femur and that of Moore, approaching its posterior aspect.
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The authors have studied 62 cases of aplasia of hypoplasia of the fibula. They note that developmental abnormalities affect the whole of the lower limb. They describe the evolution of the bony deformities and of anomalies of the soft tissues. They conclude that discrepancy in limb length is the major factor in the prognosis and that it increases uniformally. Surgery is indicated even when a definitive prosthesis is planned. The possibility of leg lengthening must be approached with caution.
The authors describe the Dunn's technique that they have followed in 19 cases of severely displaces slipped upper femoral epiphysis. The approach was posterior, subperiosteal for preserving vascularity. The results were good in 15 cases, poor in 4 cases. The indications are detailed.
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This study analyzes the risks and benefits of Ilizarov's technique in congenital pseudarthrosis of the tibia (CPT). This was a retrospective review of 14 patients treated between 1985 and 1993 for CPT, by using Ilizarov's technique. In 12 cases, this technique was used after failure of previous surgical treatment. Realignment, end-to-end compression, and leg lengthening were undertaken in all the cases, without excision of the pseudarthrosis site. The mean fixation duration was 7.8 months. Union was achieved with the initial treatment in seven cases. Bone grafting was used in six of the seven remaining cases and achieved bone healing in three of them. Refracture occurred in one case, and ended with nonunion. At 3.5-year average follow-up, the tibia was united in nine cases. We found that the best indications for Ilizarov's technique in CPT were the normotrophic and hypertrophic types of pseudarthrosis (Apoil II), after the age of 5 years. Secondary massive bone grafting is to be considered in some cases. The major disadvantage of this method is the lack of excision of the pseudarthrosis site. Even after healing is achieved, the bone remains dystrophic and fragile and necessitates a permanent protective orthosis, until the end of bone growth.
In this retrospective study of abnormalities of the cruciate ligaments in children with fibular hemimelia, 69 knees were clinically examined, of which 20 were further investigated by means of arthroscopy or nuclear magnetic resonance imaging (NMRI) for objective evidence of ligament lesions. The study allowed the type and incidence of cruciate ligament abnormalities found in this condition to be determined. The anterior cruciate ligament was affected (aplasia or hypoplasia) in 95% of cases and the posterior cruciate ligament in 60%. Although these lesions only rarely have functional consequences in such patients, pretreatment assessment should nevertheless include an active search for their presence to avoid subluxation of the knee during femoral lengthening, should this be the chosen approach.